Drug-Induced Bruxism

Beidoun, Amanda, Diana Daman, and Houda El-Mallah

The purpose of this presentation is to define drug-induced bruxism is and discuss its possible treatments. Bruxism is characterized as the unnecessary grinding or clenching of teeth. Medications such as selective serotonin reuptake inhibitors (SSRI), anti-depressants and antipsychotic drugs have been implicated in inducing this condition as a secondary side effect in patients taking these medications. Examples of these medications include fluoxetine, fluvoxamine, paroxetine, sertraline, haldoperidol, and venlafaxine. The common mechanism between these medications that contributes to bruxism is their ability to suppress the brain chemical dopamine. One of dopamineā€Ÿs functions is to control muscular or motor activity. Possible treatments for drug-induced bruxism include an occlusal guard in which the patient can wear at night. These occlusal guards evenly distribute bite forces to protect the teeth from stresses that crack or wear them abnormally, protect tempromandibular joints from excessive bite stress that can produce pain and dysfunction, and reduce the heavy forces generated by the jaw-closing muscles. Alternative drugs such buspirone, propanolol, gabapentin, and botulinum toxin, not indicated for bruxism, may be employed to manage the symptoms of bruxism. Various published case studies attest to the relief or elimination of symptoms from bruxism after the initiation of buspirone into therapy concurrently with SSRIs, with no documented side effects. In some other published studies of label use of propanolol, a nonselective beta-adrenergic blocking agent, and gabapentin, an anticonvulsant agent, have also been shown to be effective in treating symptoms of bruxism. One study involving 18 patients (ages 3 to 40) that spanned a period of eight years, the botulinum toxin, a substance acting at peripheral cholinergic synapses to prevent the release of neurotransmitters to exert an anticholinergic effect and induce paralysis, was also shown to be effective in relieving bruxism in controlled doses. Drug-induced bruxism is relevant to the dental hygiene practice because TMJ and teeth clenching are very common now a day. Bruxism secondary to treatment with antidepressants maybe unrecognized. An in depth evaluation may be needed to assess the patients bruxism.